Provider Demographics
NPI:1003817644
Name:NORONHA, RITA (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:NORONHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6110
Mailing Address - Country:US
Mailing Address - Phone:630-874-2542
Mailing Address - Fax:630-874-2642
Practice Address - Street 1:120 W NORTH ST
Practice Address - Street 2:HINSDALE HOSPITAL / PATHOLOGY DEPARTMENT
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3348
Practice Address - Country:US
Practice Address - Phone:630-856-8750
Practice Address - Fax:630-856-7895
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD13584Medicare UPIN
IL2200030390Medicare PIN